BACKGROUND OF THE INVENTION
1. Field of the Invention
[0001] The present invention relates to an apparatus and method for subcuticular attachment
of skin surrounding an opening wherein the opening is either caused unintentionally
or by surgical procedure.
2. Description of the Prior Art
[0002] Modern day surgery using sutures and staples or the like is well defined. Generally,
the key to successfully attaching cutaneous matter is the utmost gentleness in handling
all tissue. Damaged and injured tissue leads to necrosis followed by fibrosis and
scarring.
[0003] In handling tissue for attaching the surgical ends adjacent an opening, care must
be taken in attaching the open ends to provide a minimum of the usual well-known telltale
marks in the skin. For example, the application of sutures in cutaneous surgery will
often result in the appearance of telltale crosshatch markings, whereas the use of
sutures subcutaneously allows for early removal to minimize the telltale marks. Application
of subcutaneous sutures generally refers to introduction of sutures at well below
the epidermis and dermis. Subcuticular sutures generally refer to sutures introduced
beneath the epidermis. In any event, reference to attachment of cutaneous matter below
the epidermis at any level is sometimes referred to as "subcutaneous".
[0004] Surgically attaching cutaneous matter is also accomplished by application of staples
which are generally of a metal material and are closed by action against an anvil
which causes the ends of the staple to close after piercing the skin surrounding an
opening. In either case, the portions of skin are first drawn together and then stapled
or sutured so as to hold them together until natural healing takes place. The steps
are often cumbersome to the surgeon since holding the skin together requires one motion
and stapling or suturing requires another.
[0005] To date, there does not appear to exist an apparatus which is capable of gripping
the portions of cutaneous matter surrounding an opening and drawing them together,
followed by introduction of a staple at subcuticular levels, i.e. below the epidermis.
Neither does there appear to exist an apparatus which is capable of drawing the cutaneous
matter together and firing a staple in the subcutaneous region, i.e. in the region
below the dermis. The present invention is directed to such an apparatus and method
for attachment of cutaneous matter.
SUMMARY OF THE INVENTION
[0006] A surgical apparatus for attaching at least two adjacent end portions of a medium
such as cutaneous body tissue which comprises a pair of jaws, means for moving the
jaws toward and away from each other, and body tissue engaging means extending from
each jaw and facing the opposed jaw and adapted to engage the respective opposed portions
of the medium such that when the jaws are moved toward each other said engaging means
causes the two end portions of the medium to be displaced toward each other and to
assume an irregular or undulating shape whereby an elongated member may be directed
generally medially of the medium to thereby attach opposed portions of the medium.
[0007] Means is provided to direct an elongated attaching member generally medially of the
interface and subcuticularly of the body tissue to thereby attach the end portions.
Preferably, each jaw includes a sharp pointed member positioned for engagement with
marginal end portions of skin adjacent an opening therein such that when the jaws
are displaced toward each other, the skin portions move toward each other and into
engagement and assume an undulating configuration at the interface therebetween. The
apparatus further comprises a cartridge positioned adjacent the jaws and adapted to
support a plurality of elongated skin attaching members.
[0008] Each skin attaching member is preferably a rod-like member having a sharp pointed
tip at the distal end to facilitate subcuticular penetration of the skin. In one embodiment,
each rod-like member is circular in cross section and may include at least one slot
extending at least partially around a peripheral portion thereof. In another embodiment,
the rod-like members are substantially rectangular in cross section. Indentations
may also be formed in the rods to improve retention in the tissue. This facilitates
manufacture of the rods, improves feeding of the rods and increases their retention
characteristics.
[0009] In the preferred embodiment the cartridge is adapted to contain a plurality of the
rod-like members and includes means to resiliently bias the rod-like members toward
a position for advancing the member distally toward the body tissue when the body
tissue is gripped by the sharp pointed members. The members are of length sufficient
to engage oppositely sloped skin portions as determined by the dimensions and relative
spacing of the pointed tips. Further, the rod-like members may include means on the
outer surface to retain them in position within the body tissue.
[0010] A method is also disclosed for attaching two adjacent end portions of skin surrounding
an opening comprising gripping one marginal end portion of the skin adjacent the opening
at two spaced locations, gripping the opposite marginal end portion of the skin at
a location generally medial of the two locations at which the first marginal end portion
is gripped, displacing the two end portions of skin surrounding the opening toward
each other sufficient to cause the end portions to engage each other and to assume
an undulating shape, and introducing an elongated staple into the end portions of
the skin subcuticularly, the elongated staple being of length sufficient to penetrate
at least two spaced portions of skin on the same side of the opening so as to retain
the marginal end portions together in end to end contacting relation to promote healing.
As noted, the method may comprise configuring the staple to have an irregular outer
surface to prevent the staple from working itself out of the subcuticular region.
Various configurations of the staple are also contemplated.
[0011] Preferably, the method is practiced utilizing sharp skin engaging members attached
to jaws as described to permit gripping the skin and bringing the end portions adjacent
an opening to form the undulating shape.
[0012] According to the method contemplated, the staple may also be inserted subcutaneously.
BRIEF DESCRIPTION OF THE ACCOMPANYING
FIGURES
[0013] Preferred embodiments of the invention are described hereinbelow with reference to
the drawings herein:
FIG. 1 is a perspective view of the apparatus for stapling body tissue according to
the invention;
FIG. 2 is a view from above, greatly enlarged, illustrating the pointed gripping members
of the apparatus of Fig. 1 prior to gripping the body tissue for subcuticular attachment;
FIG. 3 is a view from above, greatly enlarged and partially in cross-section, of the
pointed gripping members of the apparatus of Fig. 1, just prior to subcuticular introduction
of a staple;
FIG. 4 is a view from above, similar to Fig. 3 after subcuticular introduction of
the staple;
FIG. 5 is a view partially in cross-section, taken along lines 5-5 of Fig. 4 and illustrating
one embodiment of the subcuticularly positioned staple after firing the apparatus;
FIG. 6 is a view partially in cross-section, taken along lines 6-6 of Fig. 5;
FIG. 7 is a cross-sectional view, greatly enlarged, taken along lines 7-7 of Fig.
5, illustrating one embodiment of the staple subcuticularly embedded in the skin portions
attached thereby;
FIG. 8 is a greatly enlarged side view, partially in cross-section, illustrating the
staple cartridge which forms part of the invention;
FIG. 9 is a greatly enlarged view of an alternate embodiment of the staple of the
present invention;
FIG. 10 is a greatly enlarged view of another alternate embodiment of another staple
of the present invention;
FIG. 11 is a cross-sectional view of the staple of Figures 9 and 10; and
FIG. 12 is a cross-sectional view of several staples shown in stacked relationship.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0014] Fig. 1 illustrates the apparatus 10 for subcuticular stapling of skin, constructed
according to the present invention. The apparatus 10 includes elongated arms 12 and
14 connected as shown by end bracket 16 and resiliently biased away from each other.
The resilient outward bias may be provided naturally by fabricating the arms 12 and
14 of a resilient material such as spring steel, or optionally may be provided by
incorporating a separate resilient spring in region of connecting bracket 16.
[0015] The lower end portion of each arm is constructed as shown. Arm 12 includes an extension
or jaw 18 oriented at an appropriate obtuse angle with respect to the main portion
of the arm and arm 14 includes a similar extension or jaw 20 as shown.
[0016] The extension 20 includes sharp pointed skin gripping tips 22,24 spaced apart from
each other and extending generally downwardly and toward extension 18. Extension 18
includes a similarly shaped skin gripping tip 26 oriented generally downwardly and
extending toward extension 20. The position of skin gripping tip 26 on extension 18
is preferably such as to be located medially between skin gripping tips 22, 24 when
the arms 12 and 14 are manually brought together to grip the skin surrounding an opening
as will be described. Each skin gripping tip 26, 22, 24 includes a broad base area
to facilitate grasping the skin with minimum cutting after the sharp tip has penetrated
the surface. Alternatively, a different number of skin gripping tips could be provided
on each arm.
[0017] Referring now to Fig. 2, the basic operative principles of the invention will be
described. There is illustrated the upper surface of skin 28 surrounding an opening
such as a wound or surgically provided opening. The apparatus is positioned such that
extensions 18,20 may be positioned in contact with, and generally parallel to the
upper surface of the skin. To close the opening in the skin the extensions are advanced
downwardly against the skin sufficient to cause piercing tips 22, 24 and 26 to pierce
the skin minimally as shown. Thereafter, the arms 12, 14 are squeezed together by
the surgeon to cause the three sharp tips to join the skin portions surrounding the
opening as shown in Fig. 3, i.e. to assume an undulating, or sinusoidal shape. Then,
the staple actuating mechanism 32 is fired to cause the elongated staple 34 to penetrate
the tissue below the upper epidermal layer and to retain the separate portions of
skin in interfacial engaged relation as shown in Fig. 4. Thus, the opening in the
skin is prepared for natural permanent healing and adhesion with minimum or no scarring.
[0018] Referring to Fig. 5 there is illustrated a cross-sectional view taken along lines
5-5 of Fig. 4, showing the sharp tips 26, 22 and 24 in position securing the skin
surrounding the opening 30 with staple 34 fired in position. At this point in the
closing sequence, the inward pressure on arms 12, 14 of the apparatus may be relieved
to permit them to be opened by the resilient spring action and the sharp tips may
be removed from the skin. Depending upon the nature and size of the opening in the
skin, one or more of the staples may be fired in sequence and in adjacent end to end
relation sufficient to maintain the opening in closed condition to promote healing.
Thus, the nature of the staple and the capability of repeated firing will now be described.
[0019] The staple according to the invention is preferably constructed as a sharp tipped
elongated member of naturally bioabsorbable material such as synthetic polymers or
copolymers possessing a significant number of short-chain polyester linkages or other
readily hydrolyzable linkages in their structure as, for example, is the case with
polyglycolic acid, lactide-glycolide polymers, polydioxanone, polyalkylene glycols,
polytrimethylene carbonate, polycaprolactone, their copolymers and related materials.
One preferred material is made of a copolymer of lactide and glycolide made from approximately
90% m glycolide and approximately 10% m lactide. Another bioabsorbable material is
made of a copolymer of lactide and glycolide made from approximately 25% m glycolide
and approximately 75% m lactide blended with a homopolymer of polyglycolide so that
the total composition is composed of approximately 42% glycolide. Other bioabsorbable
materials for constructing the staple are disclosed in U.S. Patent No. 4,523,591 to
Kaplan et al. and U.S. Patent No. 4,744,365 to Kaplan et al., herein incorporated
by reference.
[0020] In the embodiment of a staple or fastening member shown in Figures 5 and 6, the fastening
member is in the form of a rod or pin having a generally circular cross-section and
must be of length at least sufficient to extend over at least two oppositely sloped
surfaces of the skin on one side of the opening in order to prevent the staple from
readily working its way out of the skin. To promote an even greater capability to
maintain the portion of the staple in the skin, the staple preferably includes up
to five or more slots 36 spaced along the length thereof to provide an irregular surface
in engagement with the skin. This provides further stability to the staple and assists
in preventing the staple from working its way out of the skin while retaining its
rod-like configuration after application. The slots 36 may extend partially around
the staple as shown in cross-section in Fig. 7, or they may be annular as to extend
completely around the staple. It will be seen that in the preferred embodiment shown
in the cross-section of Fig. 7, the slots 36 extend approximately between the 2 o'clock
and 5 o'clock positions and the 7 o'clock and 10 o'clock positions. This feature is
particularly significant in view of the undulating shape which the skin assumes at
the interface between the two faces of the opening 30, which provides an environment
for the rod to otherwise work itself out of the skin when the skin portions are shifted
due to motions of the body.
[0021] The annular slots in the staple provide sufficient ridges and surface directional
changes which engage the skin to prevent self working of the rod out of the skin.
This feature is more clearly illustrated in Fig. 6 which shows the skin portions 28
surrounding the opening in cross-section and the staple 34 embedded therewithin. In
one embodiment, the staple may be approximately .350 inch in length, have a major
outer diameter between .015 and .016 inch and a minor dimension at the slots of between
.012 and .013 inch. Preferably, the staple is of length at least equal to the dimension
between the sharp skin engaging tips 22,24 on extension 20. Clearly, however, the
dimensions may be varied, depending upon the particular application contemplated.
[0022] The circular shaped rod of Figures 5 and 6 is one example of the staple (fastening
member) of the present invention which can be utilized to fasten the undulating skin.
In an alternate embodiment shown in Figure 9, the staple 70 is in the form of a rod
or pin which is generally rectangular in cross section. In the illustrated embodiment,
it is substantially square in cross section. Rod 70 is elongated and of sufficient
length to extend over at least two oppositely sloped surfaces of the skin on one side
of the opening. The tapered tip 72 at the distal end of rod 70 has a sharp point 74
to facilitate penetration through the skin. In an alternate embodiment shown in Figure
10, rod 80 is also of substantially square cross section, and has a tapered tip 82
with a sharp point 84. The rod 80 includes an indentation 86 adjacent its distal end
and an indentation 88 adjacent its proximal end to improve the retention of the rod
by restricting proximal and distal movement. That is, since the tissue stretches during
penetration of the rod and then retracts, the edge of the indentation will restrict
movement. Although only one indentation is shown at each end, clearly additional indentations
can be formed along the length to improve retention. The indentations can be formed
on opposing surfaces or the identations can extend along all side surfaces. Proximal
end surface 87 of rod 80 and proximal end surface 77 of rod 70 are adapted to be contacted
directly by a pusher for driving the rod which will be described below. The rod is
sufficiently rigid to substantially retain its elongated shape upon insertion. The
rectangular shaped configuration of the rods facilitates stacking of the rods within
staple cartridge 40 as described below. This configuration also provides for improved
retention within the skin as the rods do not work their way out of the skin as easily
as the rounded shaped rods.
[0023] The rods of Figures 9 and 10 also have the advantage in accommodating inaccuracies
in molding techniques. Line P represents the parting line of the two half molds utilized
in forming rods 70 or 80. The accuracy of molding the rods of Figures 9 and 10 can
be improved by forming the rod with cut edges 90 so that the parting line P for the
half molds is located at a non-critical point i.e. along edges 90. That is, the more
critical dimensions (e.g. length) of edges 92, 94, 96 and 98 can be maintained substantially
constant even if the edges 90 are not aligned as a result of joining the two half
molds during formation of the rod. In other words, any variation in the widthwise
dimension as a result of misalignment during formation will not significantly vary
the length of the more critical edges.
[0024] Cut or flattened edges 90 also provide a smoother surface for the rods 70, 80, thereby
preventing cutting of the tissue which might otherwise occur if the junction of edges
92, 94, 96, 98 was a single point as in a perfect square.
[0025] Clearly, other shapes of rods are within the scope of the present invention as long
as they are sufficiently elongated to penetrate at least one of the undulating portions
of the opposing skin areas. For example, rods of hexagonal cross section could be
provided.
[0026] The dimensions of the rod can vary depending on its use. By way of example only,
in one embodiment the length of the rod 70 can range from .440 to .445 inches, the
length of each side edge (e.g. edges 92, 94, 46 and 98) can range from approximately
.0245 to .0265 inches and the length of edge 90 can range from approximately .0036
to .0056 inches. In this embodiment, the tapered tip forms a point at an approximate
30 ° angle and the tip portion can have a length ranging from approximately .0653
to .0693 inches. If an indentation is provided, the indentation can have a depth of
approximately .003 to .004 inches. Clearly, these dimensions are provided solely by
way of example as rods of other dimensions are also within the scope of the present
invention.
[0027] Referring to Fig. 8 in conjunction with Fig. 1, one embodiment of a staple cartridge
is illustrated which can provide repeated firing of staples subcuticularly into the
skin as shown in Fig. 1. The apparatus includes a central arm 38 with staple cartridge
40 attached to the lower end. The cartridge contains a plurality of staples 34 in
vertically stacked relation as shown in Fig. 8, biased downwardly toward the firing
chamber 42 by a plunger 44 and resilient spring arrangement 46 shown schematically
in Fig. 8. Thus after each staple is fired, the staple next in line automatically
positions itself in the chamber 42 under downward action of plunger 44. The cross-sectional
dimension of chamber 42 is equal to or slightly greater than the major diameter of
the staple 34 to facilitate a snug fit for the staple in the chamber. The length of
cartridge 40 and chamber 42 is at least equal to the length of the staples.
[0028] The configuration of rods 70 and 80 facilitates stacking as they can be stacked along
their straight edges. Rods 70 can be vertically stacked in a similar fashion as rods
30. Alternately, as shown in Figure 12, rods 70 can be diagonally stacked along edge
94. This advantageously conserves space as compared to the vertical stacking of rods
30. Rods 80 can be stacked in a similar fashion as rods 70. Clearly, the cartridge
would be appropriately configured to accommodate the diagonally stacked rods.
[0029] The firing mechanism includes a staple firing plunger in the form of a flexible plunger
wire 48 which is slidable through staple firing chamber 42 to engage the staple next
in line to cause it to advance into the skin at a subcuticular level. The cross-section
of firing wire 48 approximately matches the cross-section of staple 34 or of staple
70 and is attached at the proximal end to rod 50 as shown in Fig. 1, which is slidable
within opening 54 in guide housing 56 such that proximal upward movement of rod 50
causes withdrawal of wire 48, and distal downward movement thereof causes firing action
by wire 48 on staple 34. Staple firing may be accomplished by manual downward distal
movement of ring 58 attached to rod 50 as shown by set screw 52. Withdrawal of firing
wire 48 out of firing chamber 42 is accomplished by manually moving ring 58 (and rod
52) proximally upwardly to permit the next staple 34 to enter the firing chamber 42
under downward action of spring 46. Further guidance for rod 50 is provided by proximally
located second external guide housing 60 which contains a second guide opening 62
for reception of rod 50. Thus the two guide housings 56 and 60 serve to firmly position
rod 50.
[0030] The firing movements of wire 48 may be adjusted by resetting the position of rod
50 relative to ring 58 by loosening set screw 52 and setting the desired position
of rod 50. Further, it is noted that guide openings 54 and 62 are circular in cross-section
almost equal to or slightly greater in dimension than rod 50. Sufficient clearance
is provided to guide rod 50 yet to maintain steady slidable movement of the rod. Plunger
wire 48 has a cross-sectional dimension slightly less than staple firing chamber 42
but sufficient to maintain steady distal and proximal movement therewithin while engaging
the proximal end face of the staple. The staple 34 and the firing wire 48 are similarly
dimensioned in cross-section, at least at the proximal end, such that engagement of
the proximal surface of the staple by the wire 48 results in even and steady distal
movement of the staple when the wire is advanced distally.
[0031] In operation, the apparatus is inserted into the opening in the skin closest to one
end with the jaws 18, 20 positioned in respective engagement with the opposed marginal
skin portions adjacent the opening. The jaws are advanced toward the skin sufficient
to cause the sharp tips 26, 22 and 24 to grip the skin by piercing the outer layer
or layers. Thereafter, the arms 12, 14 are manually drawn together to cause the skin
to engage each other and to form an irregular, or undulating shape. At this time,
the staple 34 is fired into the cutaneous matter as shown in Fig. 4 to retain the
opposed skin portions together. The jaws are then withdrawn from the skin and the
procedure is repeated in the area next adjacent the inserted fastener a sufficient
number of times to close the entire opening in the skin.
[0032] Although a preferred embodiment of the multiple fire staple cartridge has been described,
the structures and embodiments of alternative staple magazines may be utilized in
combination with the multiple tip attachment feature which permit subcuticular stapling
of an opening in body tissue. Further, although the preferred embodiment herein contemplates
subcuticular attachment of cutaneous matter, it is well within the contemplated invention
to apply such staples at subcutaneous levels, ie. below the epidermis and dermis.
Such applications would involve minor variations of the dimensional relation between
the sharp tips 22,24 and 26 and the staple firing chamber 42.
[0033] It can be readily appreciated that a surgical opening or wound in the skin can be
stapled utilizing the apparatus of the invention, leaving little or no extraneous
staple markings or puncture wounds. Further, the resulting opening in the skin can
be attached with greater precision and accuracy with the result that improved heating
may be promoted with less visible wound indicia.
1. Surgical apparatus for attaching at least two adjacent end portions of a medium
such as cutaneous body tissue, which comprises:
a) a pair of opposed jaws;
b) means for moving said jaws toward and away from each other; and
c) body tissue engaging means extending from each jaw and facing the opposed jaw and
adapted to engage the respective opposed portions of the medium such that when the
jaws are moved toward each other said engaging means causes the two end portions of
the medium to be displaced toward each other and engage at the interface thereof so
to assume an irregular shape whereby an elongated member may be directed generally
medially of said medium interface to thereby attach the opposed portions of the medium.
2. Apparatus according to claim 1 wherein at least two elongated arms are connected
to each other at one end portion and resiliently biased away from each other at the
free end portion and said jaws are each respectively positioned at the free end portion
of one of said arms.
3. Apparatus according to claim 2 wherein said body tissue engaging means on said
first jaw includes at least one sharp pointed member extending away from said jaw
and generally toward said opposite jaw, and said body tissue engaging means on said
second jaw includes at least two sharp pointed members extending therefrom and generally
toward said first jaw.
4. Apparatus according to claim 3 wherein said two sharp pointed members are positioned
in spaced relation on said second jaw and said sharp pointed member of said first
jaw extends toward said second jaw at a location generally medially between said two
sharp pointed members of said second jaw.
5. Surgical apparatus as claimed in any one of the preceding claims, further comprising
means to direct an elongate attaching member generally medially and subcuticulary
of the body tissue at the interface to thereby attach the end portions.
6. Apparatus according to claim 5 further comprising a cartridge positioned adjacent
said jaws and adapted to support a plurality of elongate attaching members, said cartridge
including means to resiliently bias said elongate members toward a position for advancing
the elongate member distally toward the body tissue when the body tissue is gripped
by said sharp pointed members.
7. Apparatus according to claim 5 or 6 including elongate attaching members, constructed
of a bioabsorbable material.
8. Apparatus according to claim 5, 6 or 7 including elongate attaching members, each
of which is a rod-like member having a sharp pointed tip at the distal end to facilitate
penetration of the body tissue.
9. Apparatus according to any one of claims 5 to 8, including elongate members, each
of which includes at least one partially annular slot extending over surface portions
thereof to retain said elongate member in position within the body tissue.
10. Apparatus according to any of the claims 5 to 9 wherein said directing means comprises
means for individually advancing each elongate member subcuticularly into the body
tissue for attachment of the two end portions thereof while the end portions are retained
in engaged relations by said sharp pointed members.
11. Apparatus according to any one of claims 5 to 10 wherein said means for advancing
said elongate attaching member subcuticularly into the body tissue is an elongate
flexible member of approximately the same cross-sectional dimension and shape as said
elongate attaching member and positioned to engage one end portion of said elongate
attaching member to cause distal movement thereof into the body tissue.
12. Apparatus according to claim 11 and as dependent on claim 6, further comprising
an elongate rigid rod attached to said flexible member for guided movement toward
and away from said cartridge and said elongate members.
13. Surgical apparatus for attaching two portions of cutaneous body tissue comprising:
a pair of opposed jaws each having a member to engage one portion of the body tissue;
means for moving at least one of said jaws towards the other jaw to move said body
tissue portions toward one another;
a chamber disposed proximally of said jaws for holding a plurality of rod-like members;
and
a plurality of rod-like members disposed in said chamber, each rod being elongate
and of sufficient length to penetrate said two body tissue portions when drawn together.
14. Apparatus as claimed in claim 13, wherein each said rod-like member has a tapered
tip having a sharp point for penetrating the tissue and has at least three sustantially
planar outer surfaces extending longitudinally therealong.
15. Apparatus as claimed in claim 13 or 14, wherein said rod-like member is substantially
rectangular, square, or hexagonal in cross section.
16. Apparatus as recited in claim 13, 14 or 15, wherein said chamber is dimensioned
to receive said rods in diagonally stacked relationship.
17. Apparatus as claimed in claim 13, further comprising an indentation formed in
said rod-like member to restrict linear movement of said member after insertion into
body tissue.
18. Apparatus as claimed in claim 13 wherein said rod-like member is composed of a
bioabsorbable material.
19. A surgical fastening member for attaching at least two portions of cutaneous body
tissue, the member comprising a substantially straight elongate body member of sufficient
rigidity to substantially retain its elongate shape upon insertion into the body tissue,
said elongate body member terminating in a tapered tip portion at one end and being
configured at the opposite end to permit full insertion into cutaneous body tissue
portions, and said elongate member being dimensioned to penetrate said at least two
portions of cutaneous body tissue when said tissue portions are drawn towards each
other.
20. A surgical fastening member as claimed in claim 19, wherein said fastening member
is substantially rectangular in cross section.
21. A surgical fastening member as claimed in claim 19 or 20, wherein said elongate
member has at least one planar surface extending longitudinally along said member
which facilitates stacking said rod-like member laterally in face- to-face contacting
relationship on said respective planar surface.
22. Fastening means, for use in a method of attaching two adjacent end portions of
skin surrounding an opening, the method comprising:
a) displacing the two end portions of skin surrounding the opening toward each other
in a manner to cause said portions to engage each other and to assume an irregular
shape at the interface; and
b) introducing an elongate fastener into the end portions of the skin subcuticulary,
said elongate fastener being of length and shape sufficient to penetrate at least
two spaced portions of skin on the same side of the opening so as to retain the marginal
end portions thereof together in end-to-end contacting relation to promote healing.
23. Fastening means according to claim 22 wherein said step of displacing the two
end portions of skin together comprises:
a) gripping one marginal end portion of the skin adjacent the opening at two locations;
and
b) gripping the opposite marginal end portions of the skin at a location generally
medial of the two locations at which the first marginal portion is gripped.
24. Fastening means according to claim 23 further comprising releasing the skin portions
after introduction of said elongated fastener, moving to a different skin location,
then repeating said steps of displacing the end portions of skin toward each other
and introducing said elongate fastener into the end portions of skin subcuticularly.
25. Fastening means according to claim 23 or 24 wherein successive said fasteners
are individually and squentially introduced into skin portions subcuticularly after
completion of each step of displacing the end portions of skin toward each other.
26. Fastening means according to claim 22, 23, 24 or 25 further comprising configuring
said fastener to have an irregular outer surface thereby to prevent it from working
itself out of the subcuticular region.